Provider Demographics
NPI:1992341895
Name:SURGICALISTS OF CA PC
Entity type:Organization
Organization Name:SURGICALISTS OF CA PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MIT
Authorized Official - Middle Name:
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-530-5043
Mailing Address - Street 1:PO BOX 21647
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33622-1647
Mailing Address - Country:US
Mailing Address - Phone:813-866-1959
Mailing Address - Fax:813-530-5043
Practice Address - Street 1:155 N JACKSON AVE STE 201
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1925
Practice Address - Country:US
Practice Address - Phone:408-770-5224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-26
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty